Clinical Trials Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2020; 26(43): 6867-6879
Published online Nov 21, 2020. doi: 10.3748/wjg.v26.i43.6867
Comparison of two supplemental oxygen methods during gastroscopy with propofol mono-sedation in patients with a normal body mass index
Liu-Jia-Zi Shao, Yi Zou, Fu-Kun Liu, Lei Wan, Shao-Hua Liu, Fang-Xiao Hong, Fu-Shan Xue
Liu-Jia-Zi Shao, Yi Zou, Fu-Kun Liu, Lei Wan, Shao-Hua Liu, Fang-Xiao Hong, Fu-Shan Xue, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Shao LJZ and Zou Y contributed equally to this study, study design/planning, study conduct, data analysis, and writing and revising the paper; Liu FK assisted with study conduct, data analysis, and revising the paper; Wan L assisted with study design/planning, study conduct, data analysis, and revising the paper; Liu SH assisted with study conduct, data analysis and curation, and revising the paper; Hong FX assisted with study design/planning, study conduct, data analysis, and revising the paper; Xue FS assisted with study design/planning, study conduct, and writing and revising the paper.
Supported by “Renfu” Research Fund by Chinese Society of Digestive Endoscopy, No. CSDE012017120006.
Institutional review board statement: This study was approved by the Institutional Ethics Committee of Beijing Friendship Hospital, China (Ethics Committee number: 2017-P2-009-02).
Clinical trial registration statement: This study is registered with the Chinese Clinical Trial Registry (registration No. ChiCTR-IOR-17013089).
Informed consent statement: The written informed consent was obtained from each patient included in the study.
Conflict-of-interest statement: No external funding or competing interests declared.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Shan Xue, MD, Professor, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, Beijing 100050, China. fushanxue@outlook.com
Received: July 19, 2020
Peer-review started: July 19, 2020
First decision: August 8, 2020
Revised: August 10, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: November 21, 2020
Processing time: 121 Days and 20.3 Hours
ARTICLE HIGHLIGHTS
Research background

Hypoxemia by respiratory depression and airway obstruction during upper gastrointestinal endoscopy with sedation is a common concern. The nasal cannula is one of most convenient tools for supplemental oxygen, but it cannot overcome upper airway obstruction. Compared to the nasal prongs, the convenient nasopharyngeal airway provides improved efficiency of supplemental oxygen delivery during upper gastrointestinal endoscopy with sedation, but the insertion of the nasopharyngeal airway is an invasive procedure with a potential risk of airway injury.

Research motivation

In view of the significant limitations of available supplemental oxygen methods, it is necessary to identify new effective measures for supplemental oxygen during upper gastrointestinal endoscopy with sedation. The Wei nasal jet tube (WNJT) is a new design of special nasopharyngeal airway made of soft material. The available evidence indicates that with a low oxygen flow, compared to nasal cannula, the WNJT does not decrease the occurrence of hypoxemia during upper gastrointestinal endoscopy with propofol sedation. Given that increasing oxygen flow improves the efficacy of supplemental oxygen in the upper airway, we designed this study to compare the efficacy and safety of WNJT and nasal prongs for supplemental oxygen delivery during gastroscopy with sedation in patients with a normal body mass index when a moderate oxygen flow was provided.

Research objectives

In this study, we aimed to determine whether the WNJT performs better than the nasal prongs for the prevention of hypoxemia during gastroscopy with propofol mono-sedation when a moderate oxygen flow is provided.

Research methods

To address whether the WNJT performs better than the nasal prongs for the prevention of hypoxemia during gastroscopy with propofol mono-sedation when a moderate oxygen flow is provided, we designed this study as a prospective randomized controlled trial in which patients undergoing elective gastroscopy with propofol mono-sedation were randomized into one of two groups to receive either the WNJT or the nasal cannula supplemental oxygen with a 5-L/min flow. The primary endpoint was the incidences of hypoxemia or severe hypoxemia during gastroscopy.

Research results

A total of 291 subjects were randomized into two groups, but a total of only 144 patients were used for data analysis because 3 patients in the WNJT group were excluded. The total incidence of hypoxemia and severe hypoxemia during gastroscopy was significantly lower in the WNJT group than in the nasal cannula group. In the WNJT group, however, epistaxis by device insertion occurred in 7 patients.

Research conclusions

With a moderate oxygen flow of 5 L/min, compared to nasal prongs, the WNJT is more effective for the prevention of hypoxemia during gastroscopy with propofol mono-sedation, but resulted in slight epistaxis in a few patients.

Research perspectives

With a moderate oxygen flow of 5 L/min, the WNJT performs better than the nasal prongs for the prevention of hypoxemia during gastroscopy with propofol mono-sedation in patients with a normal body mass index. Thus, the WNJT may represent a useful tool for supplemental oxygen during gastroscopy with propofol mono-sedation. Because the WNJT insertion results in a risk of slight epistaxis in a few patients, the risk-benefit ratio of using the WNJT should be considered.